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INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />Facility Address: <br />Telephone: <br />Person Filing <br />Report 73 <br />Tank I Size Product <br />C�6- ) )Ke'7 co <br />d'6-7) zttl -L <br />3 a W'a <br />I hereby certify under penalty of perjury that all inventory variations for <br />the above mentioned facility were within the allowable lissits for this <br />quarter. (No in Column D of the Inventory Reconciliation Sheet) <br />Inventory variations exceeded the allowable limits for this quarter. I <br />hereby certify under penalty of perjury that the — rce for the variation <br />was not due to an unauthorized (leak) releise. (Y in Column 13 of the <br />Inventory Reconciliation Sheet) <br />1 <br />List date, tank f, and amount for all variar'ins that exceeded the <br />allowable limits. <br />Date Tank E Amount <br />Z. FV 3. o <br />4. OCT 5 1988 <br />5. <br />E."Wip)ONMENTAL HFALTH <br />PERMIT / SERVICES <br />Additional dates/amounts shall be continued on a separate sheet of <br />paper and attached. <br />If the source of the variation which exceeded allu,...ible limits was due to <br />A leak the incident sha11 be reported to S.J.L.1i.D. Environmental liralth <br />within 24 hours and an unauthorized release report submitted. <br />The Quarterly summary report shall be submitted within 15 days of the end of c.ich <br />Quarter. <br />Quarter I - January --) mirch <br />Q,iarter 2 - April --> Juni- <br />Quarter 3 - July --) September <br />Quarter 4 - october --) tkrcembcr <br />Send to: SAN JOAQU IN [.00A[. HEA1_11i U I ` TIC I CT <br />1601 IF— Hazelton. P.O. Box <br />SLockcon. CA 95201 460-67"-,'. <br />T 40 l0/86 <br />